Dubai plastic surgeons are seeing ever younger patients come through the doors for preventative treatment, as well as growing numbers of men. (Shutterstock)

Dubai is seen by many as the plastic surgery hub of the world, or at least the Middle East, but the industry is no longer the stereotyped preserve of the older woman.

Dubai plastic surgeons are seeing ever younger patients come through the doors for preventative treatment, as well as growing numbers of men.

One of the final taboos in plastic surgery has been surmounted says Dr Matteo Vigo, Chief Medical Officer at the American Academy of Cosmetic Surgery Hospital, the largest aesthetic medicine practice in the UAE.

Vigo says Dubai now has 56 surgeons per one million residents – twice the number of “the house of plastic surgery” Brazil, where there are 23 surgeons for the same number.

“The number of men coming for plastic surgery/aesthetic medicine is increasing in a very impressive way. We have a lot of people coming for fillers, botox, young people, not only old men. It’s increasing, every month - we can see the trend.”

The hospital’s statistics show that while 18 per cent of its clients were male in 2013, in the first half of this year that rose to 26 per cent. That’s far ahead of the global average which, according to figures from the ISAAPS, reached 14 per cent last year.

Dubai resident Giorgio Conti had liposuction last October on his hips and stomach and is pleased he took the plunge. According to International Society of Aesthetic Plastic Surgeons (ISAPS) figures, liposuction was the second most popular procedure globally last year, just behind eyelid surgery, with 1.4 million operations.

“I was not confident with my body; I was not so fat and not too fit. I always did a lot of workouts at the gym but there was always a small layer of fat.”

No matter how many hours he put in at the gym or changes he made to his diet, nothing seemed to shift this stubborn layer, he says. So after years of consideration, the Italian native decided to go ahead with the Dh25,000 ($6,806) procedure.

“There was not another option for my case,” he said.

Conti says he doesn’t believe there is a difference in how socially acceptable plastic surgery is between the genders any longer, but there is a difference in what support men can access – meaning they are often more reluctant to go through with treatment.

“I think the approach of the ladies is much faster. The guys going for plastic surgery, I think they think much more…the girls have many more examples around them, it’s easier for them to talk with their friends.”

Conti says he didn’t have “the pleasure” of any other men in the same boat to talk to, which is why he took so long deciding to get the liposuction.

The ever-expanding menu of procedures men have to choose from include popular hair transplants, which can be done for Dh15,000 ($4,000); gynaecomastia surgery to reduce fat deposits from the chest area, which can be completed starting from Dh12,000 ($3,266); pectoral and bicep augmentationand implants for about Dh30,000 ($8,000); and apparently increasingly popular penile enlargements that start from about Dh25,000.

While the thought of the last procedure may make many men feel squeamish, Vigo says he is witnessing growing demand.

“The penis enlargement is something that’s being requested more day-by-day. We have started now a cooperation with two urologists who do this thing, so we can have more of a turnover for this [procedure].”

Like any other surgery it comes with risks “but we believe that choosing the right surgeon, the right environment, you may have minor complications that can be solved quick time”.

Grow-your-own breasts

Other trends are in the realm of preventive medicine.

“Anti-aging and regenerative medicine is taking the bulk everywhere in the world. You’ll approach the patient not only to have a treatment for a problem but you have to prevent future problems. You will screen them like you’re doing for cancer, you’ll screen them for the wrinkles, for hair loss. There are a lot of different techniques.”

At this rate, Vigo accepts there will be an increasing physical divide between those who have used cosmetic medicine and the have-nots. He is treating growing numbers of women in their twenties with botox.

“By blocking some part of the muscles they will not have wrinkles within the next 10 years, so when they reach 40 they will be perfect.”

Like every other branch of medicine, stem cell treatment is also revolutionizing plastic surgery. One such method that is being developed is a type of grow-your-own boob job, where stem cells will be injected directly into a women’s breasts.

“Instead of putting stem cells in the lab culture to expand them, they want to put them into the breasts to give some signal to expand to reach the volume the patient wants. So with just a minimum amount of fat you can harvest you place the stem cells in the breast and then they will grow by themselves but this is something fantastical now.”

Vigo says this kind of technology is probably 20 years away.

The dangers of a plastic generation

With all the quick fix-its becoming available, like bariatric surgery and liposuction, Vigo acknowledges there is a legitimate concern people will turn to the surgeon’s knife in favor of good old-fashioned healthy living.

“The problem is that the next generation will be lazy, they are all sitting playing video games with mobiles. This is unfortunate for the future. The active people will be less and less and that can lead to beautiful but unhealthy people, because they think with plastic surgery they can do whatever they want – and it’s not true.”

Vigo says plastic surgeons are not magicians but exist to give people a “second chance”, for example helping people get rid of excess fat that is obstructive to their fitness regime.

“If you come to me for liposuction but I understand you will not change your lifestyle, just ‘I do liposuction so I can eat more then the doctor will remove it for me’, this is a patient who will not bring the generation a further step.”

There is a responsibility on surgeons to properly screen patients to understand their motivations and intentions. Unfortunately, not all surgeons are so obliging.

“Some colleagues are not ethical and they just go for the money. When I say no to a patient, ‘Don’t go for it, it’s dangerous for you’ and he says ‘I will go to another doctor, he will do for me’, I say ‘Choose your doctor carefully’. Check the credentials of the doctor, what society he is in, which publications he’s written in, try to understand really whether you can trust that doctor or not.”

Conti agrees patients need to be sure they can trust the advice of their surgeon to avoid an excessively plastic generation.

“If it becomes much more accessible then many people will become too much into plastic surgery. So it will be up to the doctor to suggest to them – if the doctor is crazy as well, then probably they’re going to make crazy work.”

When things go wrong

Vigo says he is increasingly having to fix mistakes made by unlicensed or inept surgeons. Removal of dangerous fillers is something common in the GCC where filler operations are prolific.

“We struggle every time to remove them.”

One patient Vigo saw had developed tough “elephant skin” from silicon filler she had injected in a bid to get a Kim Kardashian-style backside.

“The skin was like an elephant, all rough, all round the buttocks. She said ‘What can I do?’ I said ‘…I cannot do anything’.”

The 2014 Annual American Academy of Facial Plastic and Reconstructive Surgery Survey blamed “the rise of the selfie,” and there may be something to that.

We’re taking more pictures of ourselves and each other than ever before and our exhibitionist lives are leading to a pressure for beauty that is starting at an ever younger age. We use Photoshop, Instagram filters and other enhancements to project our best looks to the world. Plastic surgery doesn’t seem so crazy as the next step anymore.

We’re perfecting our best angle in every picture we snap and changing ourselves to improve on it. One of the most visible examples of this is Kylie Jenner who, at the age of 16, went from an awkward but still very pretty teenager to an unrecognizable bombshell. Though she only admits to having her lips plumped, speculation is that her butt, breasts and nose have all been done as well.

Kylie addressed her changed lips during an episode of her family’s hit show “Keeping Up with the Kardashians.” In it, she said she had always felt insecure about her looks and so she had fillers put in to boost her lips.

Of course, even before her father, Bruce Jenner, transitioned to Caitlyn, this was clearly a family that took their plastic surgery very seriously. So it’s not a huge surprise that Kylie started so young.

It’s not just Kylie, of course, though her prominence on our TV screens makes her a target of our “did she or didn’t she” plastic-surgery fascination. In the past, good cosmetic work went unnoticed while bad cosmetic work caused us to ask “is that the girl from Dirty Dancing?!”

Now even good cosmetic work is obvious and the stigma around it practically erased — most of the time.

Unfortunately for her, the ruse didn’t work and, in any case, when she emerged back into the public eye, her transformation was obvious.

Robert Tornambe, a plastic surgeon in NYC writing for the Huffington Post said that Gisele missed an opportunity to normalize plastic surgery. “Big deal,” he wrote “cosmetic surgery in her native Brazil is more common than getting a manicure.”

The documentary film “Waiting for ‘Superman,’ ” which looked at the failures of the American public-school system, found that while Americans lagged behind all other developed countries in skills like math, our children were No. 1 in confidence. It’s exactly this cult of self-esteem that we promote from a young age that makes the plastic-surgery boom all the more perplexing.

We tell kids they’re amazing just the way they are, even when they’re not, yet they don’t just learn to accept the imperfect parts of themselves. Maybe if we were honest that no one is perfect, it would ease the concern kids feel as they become imperfect teenagers.

Or maybe the future is inflated lips and butts for everyone. Could go either way.

When 21-year-old Shelburne resident Melinda Ann "Mandy" Fortuna died late last year in her sleep, her parents searched for answers surrounding the mysterious death.

In November, a story appeared in the Burlington Free Press about a New York family who said their son, Joshua Drake, had cerebral palsy and was harmed permanently by Botox treatments for leg spasms. That story, Fortuna's loved ones say, provided the first clue into the death of Mandy, who, like the New York boy, had cerebral palsy and had been receiving Botox treatments for spasms, said her father, Mike Fortuna.

"It came about seven or eight weeks too late," Mike Fortuna said of the news. "Nonetheless, we were perplexed by the whole thing. We didn't understand what had happened to her, and now we know."

Mike Fortuna and his wife, Susan, sought out Texas lawyer Ray Chester, who represented the Drake family in a November trial against Allergan, the company that manufactures Botox.

The Fortunas filed a federal lawsuit against Allergan late last week. The claim accuses the drug manufacturer of failing to warn of dangers, negligence and breach of the Vermont Consumer Fraud Act.

Allergan has not responded to requests for comment. During the Drake trial, the company maintained Botox is a safe way to treat leg spasms — but a jury found against the company and awarded the Drake family nearly $7 million. The company is contesting that verdict.

Dr. Scott Benjamin, a pediatric specialist at the University of Vermont Medical Center, treated Joshua Drake and Mandy Fortuna. Benjamin declined comment through a hospital spokesman, citing pending litigation and medical privacy laws. He is not named as a defendant in the lawsuit.

Mandy Fortuna began receiving Botox treatments in 2007. The treatment caused her condition to deteriorate little by little, the lawsuit states. In 2014, her condition took a turn for the worst.

"She was continually gagging and choking, unable to clear her secretions," the complaint states. "Her breathing was shallow and Mandy had trouble holding her head up. She began to experience seizures or seizure-like spells."

Still, the doctor suggested more Botox, this time in her hands in addition to her legs, the complaint states.

Mandy, a Colchester High School student, was found dead the morning of Sept. 25 when Mike Fortuna tried to wake her for school. Mike Fortuna said the family had been in the midst of planning Mandy's next big adventure after high school.

Mandy's official cause of death, according to her autopsy, was atypical pneumonia — one of the most common complications associated with Botox overdoses, the complaint states.

"She lived a happy life," Mike Fortuna said. "It was needlessly cut short, but she came with us everywhere we went, and it's a huge void in the family."

'Off-label' uses

Documents filed in the lawsuit state that Botox is not approved by the U.S. Food and Drug Administration for treating pediatric spasticity, making such treatment an "off-label use." The majority of Allergan's sales of Botox are off-label, the complaint states, and the dangers of Botox are insufficiently disclosed by the company to doctors.

Allergan's animal studies and post-marketing reports on humans show that Botox is unsafe at doses greater than 8 units per kilogram of patient body weight, the complaint states. Testimony during the Drake case suggested that if the substance were given in overdose amounts, the drug could spread around the injected muscles and cause harmful immune responses.

Benjamin — the Colchester doctor who treated Joshua Drake and Mandy Fortuna — was contacted by Allergan multiple times throughout the 2000s and encouraged to use "unsafe high doses of Botox on children" to treat pediatric spasms, the Fortuna lawsuit alleges.

After the Drakes filed suit against Allergan, Benjamin was told in April 2014 during a deposition that he was administering Botox at overdose amounts, the complaint states. He continued to inject Mandy Fortuna with overdose amounts in June and September.

"Allergan to date has not informed Dr. Benjamin of this critical safety risk despite the fact that internal Allergan documents clearly demonstrate that 8 u/kg is the maximum safe dose," the complaint states.

In November, the Drake family was awarded $6.75 million at the conclusion of a jury trial. Benjamin testified that "he would not be convinced that 8 u/kg was the maximum safe dose of Botox unless and until a high ranking official from Allergan so informed him," according to court documents.

Preventing future cases

Like the Drake family, the Fortunas hope to prevent more Botox overdoses from happening by raising awareness about potential dangers. Mandy Fortuna received regular injections of Botox, and relatives say they never suspected the drug might prove lethal.

Mike Fortuna said the family is not suing Benjamin because loved ones believe fault lies with the product manufacturer and marketer.

"We had total trust in Dr. Benjamin and had no idea that he was injecting Mandy at levels considered an overdose by the manufacturer," Mike Fortuna said. "There was an inexplicable decline in her health and her abilities, when she had normally had a static condition. We asked Dr. Benjamin about possible links to Botox, but we were assured there weren't any."

Mike Fortuna said accepting the death of his daughter has become harder now that he believes it could have been prevented. However, the loss has motivated the Fortuna family to warn others about the possible side-effects of Botox.

"This is a vulnerable population that can't always communicate the symptoms as they arise, and the doctors seem unaware of the dangers," Mike Fortuna said. "The hope would be that the result of this is to alert more potential victims and raise this up as the serious public health concern that it needs to really become."

THE NEW MONSTERS

German model Beshine is the proud owner of the biggest breast implants in the world.

Her implants are so large that they are visible from both front and back and the topless star isn’t afraid to show them off.

31-year old Beshine, born Mayra Hills, according to RadarOnline, now has “The World’s Biggest Boobs” and is reportedly a Z-cup. Apparently Beshine has expander implants, which she injects every now and then. She last expanded her breasts in 2011, to 10,000 cc and each breast reportedly now weighs 20 pounds each.

While many large chested women complain of back pain and even opt for breast reduction or implant removal, according to the case, Beshine has said that she doesn’t suffer from back problems because she follows a back strengthening regimen.

In an interview on her website, Beshine said, “It is always an adventure to be in public with such big boobs.”

This woman Chelsea Charm claims to have the largest breasts in the world.

These boobs are not a gift from Mother Nature but the result of the now illegal plastic surgery procedure when polypropylene string is implanted into each breast irritating the breast lining, and so creating a serum which enlarges the breasts, a process which can continue indefinitely.

Now Chelsea's boobs are still growing at a rate of one inch a month. The woman says that eventually she will have her breasts reduced and the polypropylene removed.

"Most of the other girls who have had this procedure have stopped at some point so I’m just waiting for that to happen", Ms Charm said.

Each breast weights as much as two large watermelons so it means that Chelsea's everyday life is not as easy as she'd like it to be. She also has trouble eating, she has to sleep on her back and she struggles to fit into aeroplane toilets.

She also has to perform regular exercises to be able to support the breasts as they're very heavy.

Goldie Hawn is an American actress who is also a director, producer as well as an occasional singer. She is best known for her role in Sugarland Express. She is one of the actresses that got many people’s attention due to her beauty. She however decided to change her appearance for unknown reasons but the plastic surgery procedure did not turn out as expected. She has had Botox and face lifts which have not made her look any good

Daryl Hannah is an American Actress. She is best known for her performance in Steel Magnolias, Wall Street, Splash and Blade Runner. Throughout her career, many people have referred to her as a very beautiful woman. This was until she decided to have plastic surgery procedures, without a doubt, the procedures are a complete disaster because they changed her entire appearance in a bad way. The actress decided to get Botox injections which ended up giving her a face like that of a puppet. This is so disappointing because she was already ageing gracefully even before the surgery.

Donatella Versace is an Italian fashion designer who is best known for running the Versace fashion line. Donatella has for a long time been at the top of her game in the fashion industry and many people have a lot of respect for her. She was a beautiful and successful woman. She however had numerous plastic surgery procedures that ruined her appearance. She is currently unrecognizable. She has overdone her lip injections and face lifts.